Supernumerary teeth as mesiodentes in adults are a rare condition. Given that mesiodentes often interfere with the eruption of normal permanent incisors, the majority are diagnosed in teenagers. In some cases, this pathology is associated with the presence of a dentigerous cyst. Imaging techniques play a significant role in the diagnosis of cysts, particularly cone beam computed tomography (CBCT). Once the correct diagnosis is established, appropriate therapeutic measures – usually surgical – should be initiated promptly. The case presented here is that of a 55-year-old male with an extensive dentigerous cyst arising from a maxillary mesiodens. The decision was made to perform enucleation of the cyst along with the mesiodens inside it. The procedure was performed under general anesthesia. No complications were observed in the postoperative period. The histopathology report confirmed a dentigerous cyst. Radiograph images obtained 10 months postsurgery showed spontaneous bone tissue reconstruction.
Odontogenic inflammation in humans can spread to adjacent anatomical structures, causing pathological changes that are dangerous to health and, in some cases, life. In this paper, we present an unusual case of odontogenic orbital cellulitis caused by both Lactobacillus rhamnosus and Enterococcus avium, which resulted in blindness of the eye in a 25-year-old man. Orbital cellulitis is more common in children due to the relative immaturity of their immune systems whereas it is rare in adults – in most cases, it occurs as a complication of paranasal sinusitis. An accurate diagnosis requires not only a thorough clinical examination but also appropriate imaging tests (such as a computed tomography or nuclear magnetic resonance test). Successful treatment largely depends on the earliest possible implementation of pharmacological therapy. In cases where it is justified, surgical procedures to decompress and drain the abscess should also be considered. However, in the case described in this publication, the patient did not regain vision in the affected eye despite the implementation of both intensive pharmacological treatment and surgical treatment, probably due to ischemic optic neuropathy and central retinal artery occlusion caused by severe infraorbital oedema.
Retropharyngeal abscess in adults occurs rarely. In a small number of patients it arises as a complication of odontogenic inflammation, as in the case we describe. The key task in the treatment of patients with retropharyngeal abscess is to make the correct diagnosis. The image examination of choice in adult patients with suspected retropharyngeal abscess should be computed tomography with contrast. After making the correct diagnosis it is necessary to initiate the appropriate treatment (conservative or surgical). In cases treated surgically the effective and free approach to retropharyngeal space is transcervical access. The effective drainage of the retropharyngeal space using the rinsing drain devised by the authors enabled the total evacuation of residual suppurative content and prevented dangerous complications, such as descending necrotic mediastinitis, leading to the recovery of the patient. Keywords: computed tomography with contrast; drainage of retropharyngeal space; retropharyngeal abscess; rinsing drain.
ABSTRAKTRopień zagardłowy u osób dorosłych jest schorzeniem występującym rzadko. W niewielkiej liczbie przypadków jest to powikłanie zębopochodnego stanu zapalnego implikowanego przyjmowaniem metotreksatu. Przypadek taki został opisany w niniejszej pracy. W rozpoznaniu ropnia zagardłowego istotną rolę odgrywa diagnostyka obrazowa ze wskazaniem na tomografię komputerową szyi z kontrastem. Po właściwym ustaleniu rozpoznania niezbędne jest szybkie wdrożenie właściwego postępowania terapeutycznego: zachowawczego w postaci antybiotykoterapii o szerokim spektrum, a w uzasadnionych sytuacjach również chirurgicznego. U chorych leczonych chirurgicznie stosuje się przezszyjny dostęp do przestrzeni zagardłowej. W przypadku opisanym w niniejszej pracy zastosowano drenaż przestrzeni zagardłowej za pomocą drenu płuczącego własnej konstrukcji, który umożliwił skuteczne odprowadzenie treści ropnej. Postę-powanie to pozwoliło na uniknięcie niebezpiecznego powikłania, jakim jest zstępujące martwicze zapalenie śródpiersia, i umoż-liwiło całkowite wyleczenie chorego. Słowa kluczowe: dren płuczący; drenaż przestrzeni zagardło-wej; ropień zagardłowy; tomografia komputerowa z kontrastem.
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